PRESENTERS: Danny F. Ellis, PhD William Kearney

1. PRESENTERS: Danny F. Ellis, PhD William Kearney AUTHORS: Kim, MM, Williams, L., Alexander, LF, Ellis, D., Kearney, W., Williams, J., Howard, DL, Godley, PA, and Corbie-Smith, G. Building a successful intervention to address mental health issues:A community-based participatory research project for African-American churches

2. Overview • Study Overview • Background • Methods • Site Descriptions • Results • Future Steps

3. Study Overview “On visits to several community mental health centers throughout the nation, I have found that there are often excellent programs, but they were dreamed up by swivel-chair theoreticians who rarely, if ever, discussed the formation of tile programs with any individuals from the community they hope to serve. They are then bewildered when the community ignores or even flatly rejects the programs offered, excellent though they may be. There is a widespread demand by people today that they have some voice in their own health and welfare programs…”(Bruder 1971)

4. Study Overview cont’d • The African-American church as the surrogate for the medical sector. • African-American churches have been a strong source of support for their congregants. • This was a community based participatory research (CBPR) study that explored the language and perceptions related to mental health in the church.

5. Background • The Surgeon General’s Report Supplement (2001) • Called attention to racial disparities in health care in noting that science can offer effective treatment for most disorders but that “ Americans do not share equally in the best that science has to offer” . • Evidence suggests the need for publicly provided behavioral health sciences to better serve minorities. • The majority of individuals in the United States do not seek treatment for mental health issues. • African Americans, compared to Whites, are less likely to seek mental health treatment.

6. BACKGROUND CONT’D • Black churches as an entry point for successful health interventions • People who go to church are more likely to feel their congregations share the same values and beliefs • They are also more likely to receive spiritual support during crisis • “ The negro church….provides social intercourse, it provides amusement of various kinds, it serves as a newspaper and intelligence bureau,…..it introduces the stranger to the community.” • The black church serves as an extended family of the African American community. • Research has found that older African are more likely to worship interconnectivity with congregations than whites and are more likely to use religious coping skills during crisis.

7. Background Cont’d • Religious involvement lowers the mortality risks and improves health status and the quality of life for African Americans. • Pastors and off licensed mental health professionals deal with similar issues. • Dealing with issues of substance use and abuse; family issues; stress; suicidal ideation and individuals who are a threat to others. • An apparent demand for black clergy to be afforded the opportunity to be formally trained to face these issues in their churches.

8. Methods • Collaboration with African-American Christian churches in North Carolina to explore mental health issues with pastors and church members. • This exploration aims to gain a better understanding of: • Tthelanguage related to mental health; • The perceptions of individuals with mental health issues by the church and the community; • The type of resources being used to help individuals address their mental health needs; and • An understanding of specific ways in which researchers can help the community to address their mental health needs and the specific elements that should be included in a mental health intervention to truly address the needs of these collaborating faith-based communities.

9. Aim 2: methods cont’d • Research Aims and Questions: • What is the level of discussion around mental health in the African-American church and the broader community? • What are the perceptions of mental illness and how is mental healthcare perceived and obtained by parishioners of African-American churches? • What are, if any, the points of conflict between the African-American church culture and mainstream mental health and/or mental healthcare based on a medical model? • In what ways do African-American churches and their faith communities need help in order to better understand, identify, and cope with mental health issues?

10. Aim 2: methods cont’d • Questions explored concepts related to the discussion of, perceptions of, and coping mechanisms for mental health and related issues. • 39 interviews were completed to address the following aims: • To identify the signs and symptoms of mental illness and which mental health issues are most relevant to pastors and their congregations. • To share some of the fears of discussing mental health issues for pastors and congregation members. • To establish a project focus that has a level of agreement between the views and perceptions of congregation members and their pastors around mental health issues and ways to address those issues. • To define a practical framework in which individuals will feel comfortable and non-threatened when discussing and/or coping with mental health issues. • To discuss the differences in perceptions of mental health issues versus primary healthcare issues. • To explore various ways to design a practical and useful mental health intervention for faith-based communities.

11. Aim 2: methods cont’d • Qualitative analyses : • Atlas.ti • Grounded theory approach • Themes included: • Apattern of non-clinical language about mental health that was strongly faith based. • Mental health stigma • A desire for more mental health education in faith based communities.

12. Aim 2: methods cont’d • THEME: Language about mental health • “a person using that as a disease of the mind so when I think about the issue I think about people that has a sickness that they can't control “ • “the things that I've noticed about mental health people is that in most cases at some point they were really brilliant minds and then they just went south…” • “Well, they talk about them like you know, they know they are mentally ill but they, they, they try to put them into a world of themselves or a particular group to themselves. And God, you know, made all of us and He loves all of us and everything and um, I feel that they should give these people equal opportunity like they do normal people…“

13. Aim 2: methods cont’d • THEME: Mental health stigma • Interviewer: Do you have any memories of parishioners or church folk talking about mental illness sin your church? #00:05:35-2# • Subject: No, because church people tend not to talk about stuff like that. • “Yeah, because I do know, um, well family members and other people that I know that kind of take care of you know, people with some type of mental illness and um for lack of a better word, sometimes they are kind of stuck…” • “I think for me it's different than it is for a lot of people because I do understand that it's an illness…Part of my faith is understanding that healing is one of the blessings that God promised and so a lot of people think that healing is just for the body but I understand that healing is for the mind and the soul and the body. So he wants us to be completely whole. And doctors are not bad, they're good. And that's one of the ways that he brings about healing. So you try those coping skills and they're not working then by all means you need to see somebody. You might need a pill or a few pills. “

14. Aim 2: methods cont’d • THEME: Need for more education • “Well, I understand that people with mental illness, it's, it's a disease, so um, and a lot of things they do I know they don't necessarily do it because that's their choice, it's just that sometimes they really have no choice. Some of their behavior they really can't control. So I feel compassionate towards them, I wouldn't necessarily say I feel sorry for them, but I guess in some instances I do, depending. But yeah. And then I really realize that there is a need for some type of assistance. I don't think the community can provide enough assistance for people dealing with people with mental illnesses…”

15. Site descriptions • Saint Paul Baptist Church: Enfeild NC • Danny F. Ellis, PhD • Coley Springs: Warrenton NC • Pastor William Kearney

16. Results • Faith based communities are a potential strong context for delivering effective mental health information. • The findings from this qualitative study can positively inform the design of mental health interventions and the delivery of preliminary diagnostic services from within the church walls.